Introdução: Esclerose múltipla (EM) é uma doença desmielinizante e inflamatória do sistema nervoso central. Seu diagnóstico é clínico, auxiliado pela imagem de ressonância magnética, mas essa imagem não diferencia processos de inflamação e desmielinização. A tomografia por emissão de pósitrons (PET), usando radiofármacos específicos, pode ser uma ferramenta para diferenciar esses processos. O radiofármaco [11C]PK11195 se liga na proteína translocadora 18 kDa (TSPO) presente nas mitocôndrias das células gliais. O radiofármaco [11C]PIB é utilizado para detecção de placa Beta-amiloide, mas tem sido utilizado também na análise do conteúdo de mielina. Esta nova aplicação foi fundamentada na captação deste radiofármaco em substância branca. A utilização em conjunto destes dois radiofármacos pode diferenciar processos de neuroinflamação, desmielinização e remielização através da imagem PET. Objetivo: O objetivo deste trabalho é validar o uso dos radiofármacos [11C]PK11195 e [11C]PIB para estudo pré-clínico para a quantificação de neuroinflamação e quantidade de mielina, respectivamente, na progressão da doença de modelos animais de esclerose múltipla, modelo de roedores, e em seguida realizar análise de lesões em substância cinzenta e substância branca em modelo de primatas não humanos. Material e Métodos Projeto aprovado pelo comitê de ética (UNIFESP 2628300415 e FMUSP 25/15 e 0556/15). O modelo de lisolecitina em ratos (Wistar, machos) foi induzido pela injeção estereotáxica de lisolecitina 1% em dois locais do estriado direito (2 + 2 microL) e no corpo caloso (3 microL). As imagens de PET com [11C]PK11195 e [11C]PIB foram adquiridas nos tempos basal, 3 dias, 1 semana e 4 semanas após a administração estereotáxica. O modelo de encefalomielite autoimune experimental (EAE) em saguis foi induzido por injeção de glicoproteína da mielina do oligodendrócito (MOG) emulsionada em Adjuvante Incompleto de Freund (IFA) ou em Adjuvante Completo de Freund (CFA). As imagens de PET foram adquiridas antes da imunização (basal) e ± 100 dias após a imunização (final). O tecido cerebral foi utilizado para análise imuno-histológica. Resultados: No modelo de lisolecitina em rato foi observado um aumento na captação de [11C]PK11145 no corpo caloso, 25 % (P = 0,002) e no estriado, 24 % (P < 0,05) uma semana após a imunização comparando com a imagem basal. Com o [11C]PIB não foram observadas diferenças significativas. No modelo de EAE em saguis, induzido com MOG/IFA, foi possível observar uma redução significativa da captação de [11C]PIB nas regiões do esplênio do corpo caloso direito de 38,17 % (P = 0,0365), globo pálido direito, 22,75 %, (P = 0,0355), núcleo caudado direito, 29,36 % (P = 0,0284) e córtex cingulado, 18,99 % (P = 0,0453), enquanto para o grupo MOG/CFA foi observada uma redução significativa para a região do córtex motor esquerdo, 9,51 % (P = 0,0083). Com o [11C]PK11195 foi observada uma redução significativa na captação do radiofármacos na imagem intermediária do grupo MOG/IFA comparada com a captação basal nas regiões do córtex somatossensorial direito, 22,8 % (P = 0,0041), córtex de associação direito, 18,98 % (P = 0,0228), córtex subpial direito, 23,37 % (P = 0,0006) e região do núcleo caudado inferior esquerdo, 18,97 % (P = 0,0233). Nos ensaios post mortem realizados com os ratos foi possível observar na imuno-histoquímica uma correlação, entre micróglia ativada (Iba-1) e [11C]PK11195, tanto no corpo caloso como no estriado. Para os saguis foi observado correlação entre [11C]PK11195 e Iba-1 e esta não foi observada para o [11C]PK11195 e GFAP. Na histologia, foi observada uma correlação entre os dados da imagem de [11C]PIB e a técnica de luxol fast blue. Conclusão: A imagem PET com [11C]PK11195 e [11C]PIB foi eficiente para as quantificações de neuroinflamação e mielina, respectivamente, na progressão da doença dos modelos animais (roedor e primata não humano) da EM / Introduction: Multiple sclerosis (MS) is a demyelinating and inflammatory disease of the central nervous system. Its diagnosis is clinical, helped by magnetic resonance imaging, but this image modality does not differentiate between inflammation and demyelination. Positron Emission Tomography (PET), using specific radiopharmaceuticals, can be a tool to differentiate these processes. The radiopharmaceutical [11C]PK11195 binds to the translocator protein 18 kDa (TSPO) present in the mitochondria of glial cells. [11C]PIB is a radiopharmaceutical used for detection of Beta-amyloid plaques, but has also been used in the analysis of myelin content. This new application was based on the white matter uptake of this radiopharmaceutical. The use of these two radiopharmaceuticals together can differentiate processes of neuroinflammation, demyelination and remyelination by the PET imaging. Objective: The objective of this work is to validate the use of tracers [11C]PK11195 and [11C]PIB for preclinical study for the qualification of neuroinflammation and amount of myelin, respectively, in the disease progression of animal models of multiple sclerosis, rodent model, and then perform analysis of grey matter and white matter lesions in non-human primate model. Material and Methods: Project approved by the ethics committee (UNIFESP 2628300415 and FMUSP 25/15 and 0556/15). The rat lysolecithin model (Wistar, male) was induced by stereotactic injection of lysolecithin 1% at two sites of the right striatum (2 + 2 microL) and in the corpus callosum (3 microL). PET images with [11C]PK11195 and [11C]PIB were acquired at baseline, 3 days, 1 week and 4 weeks after stereotactic injection. The experimental autoimmune encephalomyelitis (EAE) model in marmosets was induced by injection of myelin oligodendrocyte glycoprotein (MOG) emulsified in Incomplete Freund\'s Adjuvant (IFA) or Complete Freund\'s Adjuvant (CFA). PET images were acquired prior to immunization (baseline) and ± 100 days after immunization (end of experiment). Brain tissue was used for immunohistochemical analysis. Results: In the rat lysolecithin model, an increase in [11C]PK11145 uptake of 25% (P = 0.002) was observed in the corpus callosum and 24% (P < 0.05) in the striatum, one week after immunization compared to the baseline image. The IFA/MOG and CFA/MOG groups showed clinical signs in 100% of the animals. The comparison between baseline and symptoms time points showed in the CFA/MOG group a significant 11C-PIB uptake reduction only in the left motor cortex, 9.5 % (P = 0.0083). For the IFA/MOG group, a significant decrease in 11C-PIB uptake was observed in the splenium of corpus callosum, 38.4 % (P = 0.0365), globus pallidus, 22.9 % (P = 0.0355) and tail of caudate nucleus, 28.9 % (P = 0.0284), being these 3 regions in the right brain hemisphere, and also in the cingulate cortex (midline above corpus callosum), 19.5 % (P = 0.0453). 11C-PK11195 uptake was significantly decreased in IFA/MOG group in the intermediary time point in the right somatosensorial cortex, 22.08 % (P = 0.0041), right association cortex, 18.98 % (P = 0.0228), right subpial cortex, 23.37 % (P = 0.0006) and left tail of caudate nucleus, 18.97 % (P = 0.0233). In the post mortem analysis performed with rat tissue, a weak correlation between activated microglia (Iba-1) and [11C]PK11195 uptake was observed both in the corpus callosum and in the striatum. For the marmosets we observed correlation between [11C]PK11195 and Iba-1 but we didn\'t observed between [11C]PK11195 and GFAP. In histology, we observed correlation between [11C]PIB and luxol fast blue. Conclusion: The PET images with [11C]PK11195 and [11C]PIB were efficient for quantifying neuroinflammation and myelin content, respectively, in the disease progression of animal models (rodent and nonhuman primate) of MS

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

L’activateur tissulaire du plasminogène (tPA) est une sérine protéase qui est synthétisée principalementpar les cellules endothéliales des vaisseaux. Initialement découvert dans le compartiment vasculaire où sa fonctionprincipale est de participer à la fibrinolyse, le tPA est aussi exprimé dans le parenchyme cérébral par plusieurstypes cellulaires comme les neurones ou les oligodendrocytes. Le tPA est impliqué dans de nombreuses fonctionscérébrales comme la plasticité synaptique ou encore la potentialisation glutamatergique. Le tPA est aussi un acteurclé de la neuroinflammation. Il active la microglie et participe à l’ouverture de la barrière hémato-encéphalique pardes effets de type cytokine et via son domaine protéase en générant de la plasmine à partir du plasminogène. Uneactivité plus importante du tPA est retrouvée dans le liquide céphalorachidien des patients atteints de sclérose enplaques (SEP). De plus, le tPA possède des aspects délétères dans son modèle murin, l’encéphalomyélite autoimmune expérimentale (EAE). Dans le but de mieux comprendre le rôle du tPA dans la physiopathologie de l’EAE,nous nous sommes intéressés à son implication dans la réponse immunitaire pendant la maladie. Nos donnéesmontrent que les animaux tPA-/- ont des scores cliniques moins importants que les animaux WT pendant une EAE.Les nombres absolus de LT CD4+, de microglie activée et de macrophages infiltrés, ainsi que de cellulesdendritiques sont moins importants dans le parenchyme spinal des animaux tPA-/- en comparaison avec lesanimaux WT. En lien avec ces observations in vivo, le tPA augmente in vitro l’activation et la prolifération des LTainsi que la sécrétion d’IL-6 par un mécanisme dépendant du domaine protéase et de la génération de plasmine.Dans des expériences in vitro en collaboration avec l’équipe du Dr Diego Clemente, le tPA induit l’augmentation del’expression des molécules du CMH de classe II et des molécules de costimulation à la surface des cellulesdendritiques et des macrophages par un effet de type cytokine, suggérant une capacité plus importante pour cescellules à présenter des antigènes en présence de tPA. Notre étude apporte une meilleure compréhension du rôledu tPA dans la réponse immunitaire pendant l’EAE et ouvre de nouvelles perspectives dans l’étude de l’axe tPA/plasmine dans la physiopathologie de la maladie. / Tissue plasminogen activator (tPA) is a serine protease, mainly synthesized by endothelial cells of vessels.Initially discovered in the vascular compartment where its main function is to participate to fibrinolysis, tPA is alsopresent in the cerebral parenchyma, and expressed by several cell types like neurons or oligodendrocytes. tPA isinvolved in many physiological brain functions such as synaptic plasticity or glutamatergic potentiation. tPA is alsoa main actor of neuroinflammation. It activates microglia and participates in the opening of the blood-brain barrier(BBB) by cytokine-like effects and via its protease domain and plasmin generation from plasminogen. Interestingly,tPA activity is more important in cerebrospinal fluid of multiple sclerosis (MS) patients. In addition, tPA revealsdeleterious aspects in experimental autoimmune encephalomyelitis (EAE), the mouse model of MS. In order tobetter understand the role of tPA in EAE physiopathology, we focused on its involvement in the immune responseduring disease. tPA-/- EAE animals present less severe clinical scores than WT animals. Our results indicate alsothat absolute numbers of CD4 + T cells, activated microglia and infiltrated macrophages, as well as dendritic cellsare less important in the spinal parenchyma of tPA-/-. In connection with these in vivo observations, our in vitro datashow that tPA increases activation and proliferation of T cells, as well as IL-6 secretion by a protease-dependentmechanism and plasmin generation. In experiments in collaboration with Dr Diego Clemente's team, our data showthat tPA increases the expression of MHC class II and costimulatory molecules on the surface of dendritic cells andmacrophages in vitro by a cytokine-like effect, suggesting a more important ability for these cells to present antigenswith tPA. Our study provides a better understanding of the role of tPA in immune response during EAE, and opensup new perspectives in the study of the tPA / plasmin axis in the physiopathology of the disease.

The societal burden of autoimmune diseases and donor organ transplant rejection in developed countries reflects the lack of effective immune suppressive drugs. The main objective of my thesis was to develop novel fusion proteins targeting receptors linked to autoimmunity; strategies that will allow the suppression of autoreactive cells while sparing resting lymphocytes. Interleukin (IL) 15 has been demonstrated to exert its effects mainly on activated T-cells triggered via their T-cell receptor (TCR). Since we found that the fusion of granulocyte-macrophage colony stimulating factor (GMCSF) to IL15 - aka GIFT15 - paradoxically leads to aberrant signalling downstream of the IL15R and blocks interferon (IFN)-gamma secretion in a mixed lymphocyte reaction (MLR), we hypothesized to use this fusokine in proof-of-principle cell transplantation models and shown that GIFT15 can indeed block the rejection of allogeneic and xenogeneic cells in immunocompetent mice. Additionally, we found that ex vivo GIFT15 treatment of mouse splenocytes lead to the generation of regulatory B-cells (Bregs). These Bregs express high levels of MHCII, IL10 and are capable to block antigen (Ag)-presentation in vitro as third party bystander cells. Moreover, a single injection of these GIFT15-generated Bregs in mice with pre-developed experimental autoimmune encephalomyelitis (EAE) leads to long lasting remission of disease. / Along those lines, we also found that mesenchymal stromal cells (MSCs) lead to the paracrine conversion of CCL2 to an antagonist form capable of specifically inhibiting plasma cells and activated Th17 cells. This mechanistic insight informed the design of a second class of suppression fusokine. Namely, the fusing of antagonist CCL2 to GMCSF - aka GMME1. We tested its potential use in autoimmune diseases such as EAE and rheumatoid arthritis (RA). We demonstrated that GMME1 leads to asymmetrical signalling and inhibition of plasma cells as well as Th17 EAE/RA-reactive CD4 T-cells. The net outcome of these pharmacological effects is the selective depletion of CCR2-reactive T-cells as demonstrated both in vitro and in vivo. / Overall, our data support the use of our fusion proteins as part of a powerful and specific immunosuppressive strategy either as directly injectable protein biopharmaceuticals or through the ex vivo generation of autologous Bregs in the case of GIFT15.

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